| National Provider Identifier [NPI]: | 1043326986 |
| Last Name Of The Provider | FORREST |
| First Name Of The Provider | AMY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | CFNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 149 N EASON BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TUPELO |
| Zip Code Of The Provider | 38804 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 745 |
| Number Of Medicare Beneficiaries | 138 |
| Total Submitted Charge Amount | 45807 |
| Total Medicare Allowed Amount | 22975.73 |
| Total Medicare Payment Amount | 14766.91 |
| Total Medicare Standardized Payment Amount | 19703.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 156 |
| Number Of Medicare Beneficiaries With Drug Services | 43 |
| Total Drug Submitted ChargeAmount | 1603 |
| Total Drug Medicare AllowedAmount | 366.67 |
| Total Drug Medicare PaymentAmount | 350.05 |
| Total Drug Medicare Standardized Payment Amount | 350.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 589 |
| Number Of Medicare Beneficiaries With Medical Services | 138 |
| Total Medical Submitted Charge Amount | 44204 |
| Total Medical Medicare Allowed Amount | 22609.06 |
| Total Medical Medicare Payment Amount | 14416.86 |
| Total Medical Medicare Standardized Payment Amount | 19352.97 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 66 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 87 |
| Number Of Male Beneficiaries | 51 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 105 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 20 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7432 |